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Flashcards in Trauma Surgery Deck (86):
1

Define Compartment Syndrome

Increased oseofascial compartment pressure which exceeds capillary pressure, leading to manifestations of nerve and muscle ischaemia

2

Define Compartment Syndrome

Increased oseofascial compartment pressure which exceeds capillary pressure, leading to manifestations of nerve and muscle ischaemia

3

Causes: Compartment Syndrome

Crush injuries
Fractures
Intracompartmental haematomas
Electric burns
Ischaemic reperfusion injuries

4

Clinical Findings: Compartment Syndrome

Swollen, tense limb
Pain on passive stretching
Pain out of proportion to clinical findings
Parasthesia
Paralysis/weakness
Pallor

5

What is Volkmann's contracture

Permanent flexion contracture of the hand at the wrist, making passive stretching restricted and painful

6

Treatment: Compartment syndrome

Fasciotomy

7

Clinical Findings: Ischaemic Reperfusion Syndrome

Elevated plasma CK levels
Elevated serum myoglobin levels
Elevated urine myoglobin levels

8

Treatment: Ischaemic Reperfusion Injury

A. Local:
Early fasciotomy
Prompt restoration of blood flow (6.5)
IV crystalloid

9

Signs of significant neck injury

hoarseness
stridor
saliva/CSF leak
odynophagia/dysphagia
bloody sputum
haematoma
bruit/thrill
neurological deficit
surgical emphysema
haemo/pneumothorax

10

Investigations: neck injury

CXR
C-spine XR
Gastrogaffin swallow
Endoscopy
CT angiogram

11

Rule of 9s

Burns:
Head: 9%
Arms each: 9%
Legs each: 18%
Back: 18%
Chest: 18%
Perineum: 1%

12

Fluid for burns patient

Parkland's Formula
4 x weight x BSA
= fluid for first 24 hours
Give half in the first 8 hours

13

Signs of acute vessel damage

Pain
Pallor
Pulselessness
Parasthesia
Paralysis
Poikilothermia

14

Hard signs: vascular injury

Pulsatile bleeding
Expanding haematoma
Absent distal pulses
Cold limb
Palpable thrill
Audible bruit

15

Soft signs: vascular injury

Assymetric extremity BPs
Stable, non-pulsatile haematoma
Proximity to major vessel
Peripheral neuro deficit
Shock/hypotension

16

Indications: ET intubation

1. cardioresp arrest
2. apnoea
3. respiratory failure
4. stridor
5. GCS < 8
10. severe max-fac injury
11. inhalation injuries
12. laryngeal fracture

17

Treatment: Pulmonary contustion

Early recognition
Analgesia
Supplemental O2
Physiotherapy
MONITOR for O2 drop

18

Define: Flail chest

Fracture of 2 or more adjacent ribs in 2 or more places, leading to paradoxical movement of the segment

19

Treatment: Flail chest

Analgesia
- intercostal nerve block
- thoracic epidural
Vital monitoring

20

Clinical diagnosis: rib fracture

Palpation reveals
1. tenderness
2. surgical emphysema

21

Managment: rib fractures

1-2: discharge if able to cough under analgesia
>3: admit, physio, cough, analgesia, intubate if necessary

22

Define: Cardiac tamponade

Collected blood in a sealed pericardial sac leads to increased pressure and reduced left ventricular end-diastolic volume

23

Findings: Cardiac tamponade

Beck's triad
1. hypotension
2. distended neck veins/raised JVP
3. muffled heart sounds

24

Investigations: Cardiac tamponade

CXR
ECG
FAST

25

Management: Cardiac tamponade

1. pericardiocentesis
2. sternotomy

26

Indications: Laparotomy

Peritonism
Fluid in abdomen without solid organ damage
Free air under diaphragm
Microscopic haematuria

27

Clinically clearing C-spine

1. pain can be assessed
2. no distracting injuries
3. no midline neck pain
4. no tenderness over cervical spine
5. no motor/sensory abnormalities
6. no limitation of active neck movement
7. no limitation to head control
(8. no high-risk injury e.g. PVA/fall from height/etc)

28

Signs: Tension Pneumothorax

Hypoxia
Air hunger/Anxiety
Severe dyspnoea
Elevated JVP
Contralateral tracheal displacement

29

Signs: Massive Haemothorax

Dull percussion
Reduced air entry
Mediastinal shift
Lung compression on affected side
Hypovolaemic shock

30

Signs: Respiratory distress

accessory muscle use
abdominal breathing
alar flaring
tachypnoea
cyanosis

31

Life threatening conditions to exclude in primary survey

Tension pneumo
Massive haemothorax
Flail chest
Open pneumo

32

Things to feel for on rectal exam in primary survey

Bony fragments
High-riding prostate
Blood

33

Focus areas of FAST

Morrison's pouch
Pouch of Douglas
Perisplenic
Pericardium

34

Differential: Free fluid in abdomen

1. solid organ damage
2. bowel perforation
3. bladder/ureteric injury
4. pancreatitis
5. appendicitis
6. perforated ulcer

35

Differential: Free air under diaphragm

1. Oesophageal tear (Boerhaave)
2. Perforated peptic ulcer
3. Perforated gastric cancer
4. Perforated diverticulum of colon
5. Perforated colon cancer
6. Abdominal trauma

36

Indications: Intercostal Drain

Pneumothorax
Haemothorax
Symptomatic pleural effusion
Empyema
Chylothorax

37

Manifestations: SIRS

1. Temp 38C
2. HR >90
3. Tachypnoea >20
4. WCC 12000

38

Differential: elevated R hemi-diaphragm

1. diaphragmatic hernia
2. recurrent laryngeal nerve paralysis

39

Signs: Oesophageal injury

Odynophagia/Dysphagia
Blood in NGT
Hematemesis/Haemoptysis
Saliva leak from neck
GIT leak from chest drain
Surgical emphysema
Mediastinitis

40

AVPU

Alert
Verbal stimuli
Painful stimuli
Unresponsive

41

AMPLE

Allergies
Medication
Past medical history
Last meal
Events of accident

42

Signs: raised ICP

Deteriorating LOC
Deteriorating respiratory pattern
Cushing reflex (high BP, slow HR)
Lateralising CNS signs
Seizures
Papilloedema

43

Classic injuries: PVA

1. tib-fib/femur fracture
2. truncal injury
3. craniofacial injury

44

Contraindications: Foley catheter

1. blood at urethral meatus
2. scrotal echymosis
3. high-riding prostate

45

Causes: Compartment Syndrome

Crush injuries
Fractures
Intracompartmental haematomas
Electric burns
Ischaemic reperfusion injuries

46

Clinical Findings: Compartment Syndrome

Swollen, tense limb
Pain on passive stretching
Pain out of proportion to clinical findings
Parasthesia
Paralysis/weakness
Pallor

47

What is Volkmann's contracture

Permanent flexion contracture of the hand at the wrist, making passive stretching restricted and painful

48

Treatment: Compartment syndrome

Fasciotomy

49

Clinical Findings: Ischaemic Reperfusion Syndrome

Elevated plasma CK levels
Elevated serum myoglobin levels
Elevated urine myoglobin levels

50

Treatment: Ischaemic Reperfusion Injury

A. Local:
Early fasciotomy
Prompt restoration of blood flow (6.5)
IV crystalloid

51

Signs of significant neck injury

hoarseness
stridor
saliva/CSF leak
odynophagia/dysphagia
bloody sputum
haematoma
bruit/thrill
neurological deficit
surgical emphysema
haemo/pneumothorax

52

Investigations: neck injury

CXR
C-spine XR
Gastrogaffin swallow
Endoscopy
CT angiogram

53

Rule of 9s

Burns:
Head: 9%
Arms each: 9%
Legs each: 18%
Back: 18%
Chest: 18%
Perineum: 1%

54

Fluid for burns patient

Parkland's Formula
4 x weight x BSA
= fluid for first 24 hours
Give half in the first 8 hours

55

Signs of acute vessel damage

Pain
Pallor
Pulselessness
Parasthesia
Paralysis
Poikilothermia

56

Hard signs: vascular injury

Pulsatile bleeding
Expanding haematoma
Absent distal pulses
Cold limb
Palpable thrill
Audible bruit

57

Soft signs: vascular injury

Assymetric extremity BPs
Stable, non-pulsatile haematoma
Proximity to major vessel
Peripheral neuro deficit
Shock/hypotension

58

Indications: ET intubation

1. cardioresp arrest
2. apnoea
3. respiratory failure
4. stridor
5. GCS < 8
10. severe max-fac injury
11. inhalation injuries
12. laryngeal fracture

59

Treatment: Pulmonary contustion

Early recognition
Analgesia
Supplemental O2
Physiotherapy
MONITOR for O2 drop

60

Define: Flail chest

Fracture of 2 or more adjacent ribs in 2 or more places, leading to paradoxical movement of the segment

61

Treatment: Flail chest

Analgesia
- intercostal nerve block
- thoracic epidural
Vital monitoring

62

Clinical diagnosis: rib fracture

Palpation reveals
1. tenderness
2. surgical emphysema

63

Managment: rib fractures

1-2: discharge if able to cough under analgesia
>3: admit, physio, cough, analgesia, intubate if necessary

64

Define: Cardiac tamponade

Collected blood in a sealed pericardial sac leads to increased pressure and reduced left ventricular end-diastolic volume

65

Findings: Cardiac tamponade

Beck's triad
1. hypotension
2. distended neck veins/raised JVP
3. muffled heart sounds

66

Investigations: Cardiac tamponade

CXR
ECG
FAST

67

Management: Cardiac tamponade

1. pericardiocentesis
2. sternotomy

68

Indications: Laparotomy

Peritonism
Fluid in abdomen without solid organ damage
Free air under diaphragm
Microscopic haematuria

69

Clinically clearing C-spine

1. pain can be assessed
2. no distracting injuries
3. no midline neck pain
4. no tenderness over cervical spine
5. no motor/sensory abnormalities
6. no limitation of active neck movement
7. no limitation to head control
(8. no high-risk injury e.g. PVA/fall from height/etc)

70

Signs: Tension Pneumothorax

Hypoxia
Air hunger/Anxiety
Severe dyspnoea
Elevated JVP
Contralateral tracheal displacement

71

Signs: Massive Haemothorax

Dull percussion
Reduced air entry
Mediastinal shift
Lung compression on affected side
Hypovolaemic shock

72

Signs: Respiratory distress

accessory muscle use
abdominal breathing
alar flaring
tachypnoea
cyanosis

73

Life threatening conditions to exclude in primary survey

Tension pneumo
Massive haemothorax
Flail chest
Open pneumo

74

Things to feel for on rectal exam in primary survey

Bony fragments
High-riding prostate
Blood

75

Focus areas of FAST

Morrison's pouch
Pouch of Douglas
Perisplenic
Pericardium

76

Differential: Free fluid in abdomen

1. solid organ damage
2. bowel perforation
3. bladder/ureteric injury
4. pancreatitis
5. appendicitis
6. perforated ulcer

77

Differential: Free air under diaphragm

1. Oesophageal tear (Boerhaave)
2. Perforated peptic ulcer
3. Perforated gastric cancer
4. Perforated diverticulum of colon
5. Perforated colon cancer
6. Abdominal trauma

78

Indications: Intercostal Drain

Pneumothorax
Haemothorax
Symptomatic pleural effusion
Empyema
Chylothorax

79

Manifestations: SIRS

1. Temp 38C
2. HR >90
3. Tachypnoea >20
4. WCC 12000

80

Differential: elevated R hemi-diaphragm

1. diaphragmatic hernia
2. recurrent laryngeal nerve paralysis

81

Signs: Oesophageal injury

Odynophagia/Dysphagia
Blood in NGT
Hematemesis/Haemoptysis
Saliva leak from neck
GIT leak from chest drain
Surgical emphysema
Mediastinitis

82

AVPU

Alert
Verbal stimuli
Painful stimuli
Unresponsive

83

AMPLE

Allergies
Medication
Past medical history
Last meal
Events of accident

84

Signs: raised ICP

Deteriorating LOC
Deteriorating respiratory pattern
Cushing reflex (high BP, slow HR)
Lateralising CNS signs
Seizures
Papilloedema

85

Classic injuries: PVA

1. tib-fib/femur fracture
2. truncal injury
3. craniofacial injury

86

Contraindications: Foley catheter

1. blood at urethral meatus
2. scrotal echymosis
3. high-riding prostate